Healthcare Provider Details

I. General information

NPI: 1972227676
Provider Name (Legal Business Name): NICOLAS ANDREAS MEOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 MIDDLEFIELD RD STE 102
PALO ALTO CA
94301-4029
US

IV. Provider business mailing address

777 N 1ST ST STE 444
SAN JOSE CA
95112-6339
US

V. Phone/Fax

Practice location:
  • Phone: 650-798-6330
  • Fax:
Mailing address:
  • Phone: 408-240-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: